In a fourth state, Montana voters rejected an expansion initiative because it was connected to a tobacco tax increase.

The Montana experience should be a lesson if Wyoming Medicaid expansion proponents plan to get a similar initiative on the state’s general election slate.

Given the Wyoming Legislature’s solid rejection of any and all Medicaid expansion bills in recent years, the citizen’s initiative appears to be the only avenue remaining to extend coverage to an estimated 20,000 low income residents who now have no health insurance.

Ex-governor Matt Mead changed his position and supported expansion during his last two years in office.

His successor, Mark Gordon, is opposed.

So here comes The Fairness Project, an advocacy group that reportedly spent six million dollars in support of the initiatives in those other four states in November, according to Stateline.com.

The group lists Wyoming among the states where Medicaid expansion initiatives could get on the ballot in 2020.

The other states are Florida, Mississippi, Missouri, Oklahoma and South Dakota.

The Fairness Project is evaluating the viability of campaigns in all six states, the project’s press secretary, Colin Diersing, said in an e-mail last week.

Meanwhile, if you’re a gambler, you can safely bet the farm or the family bungalow that the Wyoming Legislature will remain firmly entrenched against extending any parts of Medicaid coverage to the uninsured working poor.

National political analysts say they expect the movement of states toward expansion will taper off because of uncertainty over the future guarantee of federal money in the Trump administration.

That distrust of the federal government has played a large role in the multiple rejections of expansion by the Wyoming Legislature.

Yet what I found puzzling was the absence of any discernible organized opposition against expansion bills before the Wyoming lawmakers.

Instead, there was nearly unprecedented vigorous support by the entire medical community —doctors, nurses, hospitals, various health care groups — along with churches, AARP, the tribes of the Wind River Indian Reservation and some businesses, local elected officials, and, of course, low income uninsured residents.

So on to the citizens initiative ballot.

Montana’s unfortunate initiative plan offers a lesson on what not to do.

First, do not attach it to a tax on an organization like Big Tobacco with its deep pockets.

The supporters threw in the tax increase as a tactic to mollify critics who fretted that if the feds reneged on their Medicaid support guarantee, the citizens would have to make up the difference. The tax revenue, the supporters argued, would pay for any shortfall in federal money that developed.

The tobacco companies declared war against the ballot initiative and unleashed a media campaign to kill it.

The companies raised nearly $19 million and spent $17.2 million, mostly on a TV advertising blitz, according to Stateline.com.

Supporters of the initiative, with only $9.7 million, couldn’t compete.

The Montana ballot proposition failed 53 percent to 47 percent.

“The basic lesson is that if you create a big political target, don’t be surprised if people pay attention to it,” said Matt Salo, executive director of the National Association of Medicaid Directors. “If you propose to raise tobacco taxes, don’t be surprised if tobacco pushes all its chips in. The same happens when you try to raise soda taxes.”

In Wyoming, for example, it would be unwise to attach any expansion ballot initiative to a tax on beer. Beer is Wyoming’s sacred tax cow.

Even getting to the ballot stage is a hard slog with Wyoming’s tough standards for an initiative. The requirement is petitions with signatures equal to 15 percent of votes cast in the previous general election, which currently totals 38,818, from two-thirds of the state’s 23 counties. Many initiatives fail to collect the required number of signatures of registered voters.

The next bar is the requirement of votes cast on the initiative ballot. The law requires a majority of voters in the election cast ballots for the initiative, not just those voting on the measure. If an initiative fails, the proponents cannot try to get it on the ballot again for five years.

The initiative also cannot be used to change the Wyoming Constitution. Only the Legislature can do that.

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